605 - Preparing Students for the RN Role through the use of a Multi-Patient Simulation Scenario

Many simulations are one patient at a time and often limited to a 15-20-minute session. However, this multi-patient scenario involves multiple high acuity patients in sessions of up to an hour in length. The scenarios are intervention driven and require student teams to care for several unique patients (diversity, diagnoses, orders, etc.) who are moving in and out of the simulation setting. The team is responsible for shift reports, EHR documentation, execution of new, real-time orders, as well as communication with team members, physicians, and ancillary services. Debriefing is interspersed throughout to provide feedback, both positive and constructive, along with video review.

Existing literature identifies many areas where new graduate nurses are overwhelmed in the clinical setting (Ross, et al., 2021), including the handling multi-patient assignments. Nursing programs do these students a disservice in not preparing them adequately for this setting. Recognizing this deficiency in academic preparation, an associate degree nursing program in the southern United States revised existing individual patient scenarios into an extensive multi-patient scenario.
The existing individual cases were based on the NLN Core Cases, with modifications made by the course faculty. Previously, these cases were run one at a time with a debriefing period following each one. There were usually multiple students involved with one patient, which impacted individual student engagement and was not a realistic representation of the acute care settings. Through the development of the multi-patient scenario, students are now required to collaborate as a team to care for multiple patients at a time.

The multi- patient scenario begins with two active patients and a team of three students. Patients move in and out of the room based on condition and existing provider orders. The students must complete interventions and orders given by the healthcare provider. This is accomplished using a program developed electronic health record (EHR) that allows orders to be updated in real time. Students also communicate with providers and ancillary departments through use of iPads and Zoom calls.
Additionally, students must interact with transporters, family members, and other students who arrive on the unit at change of shift to receive bedside report. This is all completed in a 4-hour period, that also includes a prebriefing session and two separate debriefing sessions.
Since this was a new approach to simulation for the program, this scenario was piloted with graduating students from a previous class and faculty members. This was done to identify problems with technology, movement of “patients” and the volume of information needed by participants to be successful. The feedback from new graduates and faculty alike was incredibly beneficial and just helped to create and even better product.